Sensitivity of fine‐needle aspiration for papillary carcinoma of the thyroid correlates with tumor size

Objective: We aimed to clarify the influence of ThinPrep preparation, nodule size and guidance mode on the accuracy of thyroid fine-needle aspiration (FNA). Methods: A total of 1,240 thyroid FNAs were reviewed and 489 cases with histological correlations were enrolled in this study. Results: Of the 489 total cases examined, 101 were processed with both ThinPrep and conventional preparation and 388 entirely with ThinPrep. The overall nondiagnostic rate, sensitivity and accuracy of FNA were 2.0, 91.0 and 89.4%, respectively. The cases with a preoperative ultrasound (n = 469) were grouped according to nodule size. The nondiagnostic rate, sensitivity and accuracy of FNA did not differ significantly with nodule size (p1 = 0.339, p2 = 0.179, p3 = 0.119). A total of 101 resections were performed with palpation-guided FNA and 388 were performed with ultrasound-guided FNA. The nondiagnostic rates, sensitivity and accuracy of FNA were similar in these two groups. Conclusions: The ThinPrep technique is a valid method for thyroid FNA and is effective for thyroid nodules ≥0.5 cm. The reliability of FNA results is not reduced with larger nodules. The use of palpation-guided FNA for palpable solid nodules is also effective.

Section: Discussioncontrasting

confidence: 56%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Factors Influencing the Reliability of Thyroid Fine-Needle Aspiration: Analysis of Thyroid Nodule Size, Guidance Mode for Aspiration and Preparation Method

H¹,

Zhang²,

Zhao³

et al. 2015

“…The assumption that clinicians can reliably identify those patients who are at risk of a false-negative diagnosis from the majority of benign aspirates is not supported by the results of this study. Second, the sensitivity (not risk of malignancy) of thyroid FNA is well known and for most tumors does not exceed 90% depending on tumor type and size [56,57] . In addition, the sensitivity of FNA in this series for 9-mm papillary carcinomas was only 44%.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of False-Negative Thyroid Fine-Needle Aspirates

Renshaw

Gould²

2017

Self Cite

Introduction: False-negative thyroid fine-needle aspirates (FNA) are not well characterized. Methods: We correlated the results of all thyroid aspirations from 1997 to 2016 with histologic follow-up. Results: There were 13,733 aspirates, 2,112 (15.3%) resections, and 678 malignancies (32.1%). Eighteen (2.7%) false-negative cases were identified (interpretation, n = 6; sampling, n = 7; and new nodules, n = 5). Interpretive false-negative cases were significantly less likely when the indeterminate rate was greater than 13% (p = 0.01). Interpretive errors involved rare cells with poorly developed features of malignancy. Sampling errors were not associated with scant cellularity in the specimen. The majority of false-negative cases were not resected because of a clinical suspicion of malignancy. The sensitivity of FNA for 9-mm papillary carcinomas was 44.3%. Conclusion: In this cohort, the false-negative rate of thyroid FNA was 2.7% and the risk of malignancy for a benign diagnosis was 3.5%. Interpretative errors involved rare cells with poorly developed features of malignancy. There is little evidence that either the false-negative rate or the risk of malignancy of a benign thyroid FNA is different in patients who do and do not undergo resection.

“…Other authors have used a third category, in addition to ‘positive’ and ‘suspicious’, for papillary carcinoma [2]. The most recent example is by Renshaw [3] who uses ‘atypical cells, rule out papillary carcinoma’. In addition, indeterminate-microfollicular is equivalent to the Bethesda System’s follicular neoplasm category.…”

Section: Methodsmentioning

confidence: 99%

Timing of Repeat Thyroid Fine-Needle Aspiration in the Management of Thyroid Nodules

Singh

Wang²

2011

Objective: The Bethesda System for reporting thyroid fine-needle aspirations (FNAs) recommends repeat aspirations be done at least 3 months following the initial aspiration to prevent false-positive misinterpretations due to reactive/reparative changes. Because limited data exists, we reviewed our own data to ascertain the recommendation. Study Design: We retrospectively reviewed thyroid FNAs accessioned in the Cytology Laboratory at Beth Israel Deaconess Medical Center in Boston, Mass., USA, from January 2006 to December 2008. We identified patients with repeat aspirates of a single lesion and those with thyroidectomy specimens. Cytologic and surgical diagnoses along with time between FNAs were recorded. Results: No statistically significant difference was detected in the distribution among nondiagnostic, suboptimal, and adequate categories with respect to the timing of repeat FNA (p = 0.25). Forty-six percent of the lesions that were nondiagnostic/suboptimal initially yielded the same results on repeat. Twenty-eight percent of initially adequate specimens were nondiagnostic/suboptimal on repeat (p = 0.04). Nine percent of those with an initial atypical diagnosis had the same diagnosis on repeat, while 2.6% of those who did not have an initial atypical diagnosis had an atypical diagnosis on repeat (p = 0.29). False positives between early (16%) and late (12%) repeats were not statistically significant (p = 0.74). Conclusion: The diagnostic yield and accuracy of repeat FNA is independent of the time interval between procedures but may be related to the original FNA diagnosis.